PLASMA ENDOTHELIN DETERMINATION AS A PROGNOSTIC INDICATOR OF 1-YEAR MORTALITY AFTER ACUTE MYOCARDIAL-INFARCTION

Background Plasma endothelin concentrations are increased in the acute phase of myocardial infarction and in chronic heart failure. Since en dothelin may contribute to hemodynamic deterioration by potent vasocon strictory and cardiotoxic actions, increased plasma levels may be asso ciated with an unfavorable prognosis after myocardial infarction. Meth ods and Results We tested the hypothesis that plasma endothelin determ ination in the subacute phase of myocardial infarction is related to s ubsequent survival and assessed whether plasma endothelin measurements provide additional prognostic information to that obtained from clini cal and biochemical variables previously known to be associated with h igh mortality. Plasma endothelin determination was obtained from 142 p atients (average age +/-SD, 67.8+/-10.1 years) on day 3 after document ed myocardial infarction and was related to 1-year mortality. Sixteen patients died during the follow-up period. In a univariate Cox proport ional-hazards model, day 3 plasma endothelin concentrations were signi ficantly related to mortality (P<.0001). Patient age, previous treatme nt for systemic hypertension, presence of clinical heart failure, and plasma atrial natriuretic factor levels were all related to mortality in univariate analysis but provided no additional prognostic informati on to that obtained from endothelin determination in a multivariate mo del. Conclusions Plasma endothelin concentrations are strongly related to outcome after myocardial infarction and provide prognostic informa tion independent of clinical and biochemical variables previously asso ciated with a poor prognosis.